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Eur Arch Otorhinolaryngol. 2011 Aug;268(8):1205-1212. doi: 10.1007/s00405-011-1639-2. Epub 2011 May 24.

Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases.

Author information

1
Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France. alexandre.bozec@nice.fnclcc.fr.
2
Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
3
Département de Statistiques Médicales, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
4
Département d'Anatomie Pathologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
5
Département de Médecine nucléaire, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
6
Département d'imagerie médicale, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
7
Service d'endocrinologie et métabolisme, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 30 av de la voie romaine, 06002, Nice, France.
8
Service d'anatomie pathologique clinique et expérimentale, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 30 av de la voie romaine, 06002, Nice, France.

Abstract

The impact of cervical lymph node metastases and the optimal surgical management of the neck in patients with papillary thyroid carcinoma (PTC) remain controversial. The objectives of this retrospective study were to determine, in patients with PTC, the predictive factors and the impact on tumor recurrence rate of cervical lymph node involvement, and to evaluate the oncologic results and the morbidity of central neck dissection (CND). We reviewed the records of patients who had undergone surgical treatment for PTC at our institution between 1990 and 2000. A total of 368 patients (86 men and 282 women) were included in this study. Young age (p = 0.02), tumor size (p = 0.001) and extrathyroidal tumor extension (p = 0.003) were significant predictive factors of cervical lymph node metastatic involvement (multivariate analysis). Initial metastatic cervical lymph node involvement was identified as an independent risk factor of tumor recurrence (multivariate analysis, p = 0.01). Metastatic lymph node(s) were found in prophylactic CND specimens in 31% of the patients. CND increased the risk of postoperative hypocalcemia (p = 0.008) and of permanent hypoparathyroidism (p = 0.002). In conclusion, cervical lymph node metastatic involvement at the time of initial surgery is an independent risk factor of tumor recurrence. CND provided an up-staging of more than 30% of patients with a clinically N0 neck, but was associated with significant morbidity regarding parathyroid function.

PMID:
21607578
DOI:
10.1007/s00405-011-1639-2
[Indexed for MEDLINE]

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